Provider Demographics
NPI:1386962728
Name:SHAW, SHANNON ELIZABETH (COTA/L)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:ELIZABETH
Last Name:SHAW
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13419 MCCUTCHEON RD E
Mailing Address - Street 2:
Mailing Address - City:ORTING
Mailing Address - State:WA
Mailing Address - Zip Code:98360-9589
Mailing Address - Country:US
Mailing Address - Phone:253-278-3622
Mailing Address - Fax:
Practice Address - Street 1:502 29TH ST SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-7532
Practice Address - Country:US
Practice Address - Phone:253-939-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC00000451224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant